Academic Medicine最新文献

{"title":"Integrating Generative Artificial Intelligence Into Medical Education: Curriculum, Policy, and Governance Strategies.","authors":"Marc M Triola, Adam Rodman","doi":"10.1097/ACM.0000000000005963","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005963","url":null,"abstract":"<p><strong>Abstract: </strong>The rapid advancement of generative artificial intelligence (GAI) is poised to revolutionize medical education, clinical decision-making, and health care workflow. Despite considerable interest and a surfeit of newly available tools, medical educators largely lack both competencies and guidance on how to incorporate the new and rapidly evolving world of GAI into the core medical school curriculum and experiences of undergraduate medical education. This Scholarly Perspective highlights the need for medical schools to adapt to this new paradigm by implementing policies, governance, and curricula that address the ethical, technical, and pedagogical implications of GAI. The authors recommend creating policies for appropriate GAI use, designed to protect institutional and patient data, and provide students with clarity on the appropriate use of AI for education. The authors suggest that implementing GAI governance at institutions is crucial to create guiding principles on ethical and equitable GAI use and involving students as coinventors of local innovation. The authors argue that providing faculty and learners with tools and training for safe experimentation with GAI and defining competencies for students and faculty are essential. Curricula for GAI should focus on implications of clinical uses. The authors propose a set of new competencies for GAI that build on those already established for AI in general. Given how dynamic the world of GAI is and how quickly new innovations are changing longstanding practices of clinical medicine, it is imperative that the medical education community acts together to share best practices, gather data to assess the impact of GAI education, continuously update the expected competencies of medical students, and help students prepare for a career that will be continually changed by GAI.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Program and Institutional Coordinator Well-Being: Results From a National Survey.","authors":"Stuart Slavin, Nicholas Yaghmour, Aurea Baez-Martinez, Cormac O'Donovan, Mukta Panda, Pamela Carpenter, Coranita Burt, Kandice Kaylor McLeod","doi":"10.1097/ACM.0000000000005955","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005955","url":null,"abstract":"<p><strong>Purpose: </strong>This study explores the mental health and well-being, overall job satisfaction, likelihood to leave position, and perceptions of job satisfiers and stressors and dissatisfiers in a national sample of program and institutional coordinators in graduate medical education (GME).</p><p><strong>Method: </strong>Between August and September 2022, 11,887 program and institutional coordinators and managers with email addresses listed in the Accreditation Council for Graduate Medical Education database were emailed a survey link. The survey queried mental health using the Patient Health Questionnaire 8 depression scale, Generalized Anxiety Disorder 7, and a 2-item burnout scale derived from the Maslach Burnout Inventory; overall satisfaction with work; likelihood to leave work; and drivers of satisfaction and dissatisfaction.</p><p><strong>Results: </strong>A total of 6,372 coordinators and managers responded to the survey, with 1,367 (23.9%) reporting moderate to severe depression symptoms on the Patient Health Questionnaire 8 and 1,767 (30.4%) reporting moderate to severe anxiety symptoms on the Generalized Anxiety Disorder 7. A total of 2,069 respondents (36.3%) reported feeling burned out at least once per week, 1,288 (20.4%) reported being dissatisfied or very dissatisfied with work, and 1,510 (27.9%) reported being likely or very likely to leave their job in the next year. Positive interactions with administrative staff, residents, fellows, faculty, and program leadership were the highest ranked drivers of job satisfaction. Tracking down residents, fellows, and faculty to complete required tasks, low pay, overall workload, level of detail to manage, time pressure, lack of appreciation by faculty, and sense of entitlement of residents were leading job dissatisfaction drivers.</p><p><strong>Conclusions: </strong>Coordinators are vitally important members of the GME community who play critical roles in supporting the GME enterprise. This study aims to raise awareness of the challenges and struggles faced by coordinators to lead to improvements in their job satisfaction, mental health, and well-being.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Innovative Approach to Navigating Microaggressions in Medical Education Settings.","authors":"Nariell Morrison, Olutunmise Ashaye, Simisola Onanuga, Hannah Okechukwu, Kinan Wihba, Chioma Izzi-Engbeaya, Amir H Sam","doi":"10.1097/ACM.0000000000005946","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005946","url":null,"abstract":"<p><strong>Problem: </strong>Microaggressions negatively affect the experiences of medical students, especially those from minoritized groups, indicating the need for heightened awareness and open dialogue. The increasing recognition of the potential harm caused by such behaviors has led to a call for educational strategies that enable medical students to identify and address microaggressions effectively. This report details an innovative approach designed to navigate the complexities of microaggressions within medical education settings.</p><p><strong>Approach: </strong>In December 2023, 2 senior medical educators facilitated an in-person lecture, which consisted of short videos cocreated with students, interactive online surveys, and a presentation. The lecture aimed to enable third-year medical students at Imperial College School of Medicine to describe and recognize microaggressions and other forms of inappropriate behavior, understand the impact of microaggressions in medical education settings, develop problem-solving skills to challenge inappropriate behavior, and differentiate the informal and formal mechanisms to raise concerns.</p><p><strong>Outcomes: </strong>The final data set consisted of 183 participants. Participants reported increases in confidence in identifying microaggressions (median [IQR], 4.00 [3.00-4.00] before vs 4.00 [4.00-5.00] after intervention; P < .001), understanding their potential effect on affected individuals (median [IQR], 4.00 [3.00-5.00] before vs 5.00 [4.00-5.00] after intervention; P < .001), and feeling better equipped to challenge inappropriate experienced (median [IQR], 2.00 [2.00-3.00] before vs 3.00 [2.00-4.00] after intervention; P < .001) or witnessed (median [IQR], 3.00 [2.00-3.00] before vs 4.00 [3.00-4.00] after intervention; P < .001) behaviors. They also reported increases in confidence in seeking support from their peers if they experienced (median [IQR], 4.00 [3.00-5.00] before vs 4.00 [4.00-5.00] after intervention; P < .001) or witnessed (median [IQR], 4.00 [3.00-4.00] before vs 4.00 [3.00-5.00] after intervention; P < .001) microaggressions.</p><p><strong>Next steps: </strong>Next steps include integrating small group workshops on microaggressions into curricula and adapting these interventions for other health care professionals.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Milestone Validity in Graduate Medical Education.","authors":"Joel Yager, Richard F Summers, Sidney Zisook","doi":"10.1097/ACM.0000000000005957","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005957","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity Evidence for Using Virtual, Interactive Patient Encounters to Teach and Assess Clinical Reasoning for First-Year Medical Students.","authors":"John K Roberts, Nancy Weigle, James W Fox, Sreeja Natesan, David Gordon, Saumil M Chudgar","doi":"10.1097/ACM.0000000000005952","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005952","url":null,"abstract":"<p><strong>Purpose: </strong>Despite universal agreement on the importance of clinical reasoning skills, inadequate curricular attention to these skills remains a problem. To facilitate integration of clinical reasoning instruction and assessment into the preclerkship phase, the authors created a clinical reasoning curriculum using technology-enhanced patient simulations.</p><p><strong>Method: </strong>In 2023, first-year medical students at Duke University School of Medicine were enrolled in a biomedical science course using diagnostic reasoning sessions and 16 virtual, interactive patient (VIP) encounters to teach and assess clinical reasoning. The encounters were enhanced with interactive pop-in windows that assessed multiple clinical reasoning domains. Student responses were independently evaluated by faculty. Cumulative VIP clinical reasoning composite (CRC) scores were calculated, and growth mixture modeling was used to define students by growth trajectory. Clinical reasoning was assessed in a summative objective structured clinical examination (OSCE).</p><p><strong>Results: </strong>Of the 118 students who participated in the curriculum, 1 was excluded from analysis for inadequate participation in the VIP encounters, leaving 117 students. The aggregate VIP encounter response rate was 95% (1,783 of 1,872 assessments completed). Clinical reasoning was assessed through cumulative performance across multiple domains. The mean (SD) scores were 58 (13) for information gathering, 46 (13) for illness script identification, 64 (14) for hypothesis generation, 59 (12) for differential diagnosis, and 77 (21) for management and plan. To identify latent classes of growth in cumulative VIP-CRC scores, growth mixture modeling was performed for 1-, 2-, and 3-class models. The 2-class model showed the best fit due to having the lowest bayesian information criterion (11,765.17) and Akaike information criteria (11,737.55).</p><p><strong>Conclusions: </strong>Integrated clinical reasoning instruction and deliberate, formative practice through authentic simulations were effective at teaching and assessing clinical reasoning in the preclerkship phase. VIP and OSCE can be used to identify students at risk of low performance in the clerkship year.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premedical Course Requirements in U.S. Medical Schools.","authors":"Ahmed Ahmed, Yoseph Boku, Emma Korolik, Blake Shultz","doi":"10.1097/ACM.0000000000005951","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005951","url":null,"abstract":"<p><strong>Purpose: </strong>This study characterizes required or recommended premedical coursework, coursework fulfillment, and congruence among U.S. medical schools.</p><p><strong>Method: </strong>This cross-sectional study examined course requirements and recommendations of U.S. allopathic medical schools, using data from the 2023 to 2024 Association of American Medical Colleges Medical School Admission Requirements database. Courses required and recommended, credit hours, medical schools accepting pass/fail credits, advanced placement credits, online courses, and community college credits were evaluated.</p><p><strong>Results: </strong>Of 157 medical schools, 154 had at least 1 premedical course requirement or recommendation. No schools had the same requirements or recommendations; 113 (72.0%) required or recommended 10 or more courses. The most commonly required courses were biology (107 [68.2%]), physics (106 [67.5%]), organic chemistry (105 [66.9%]), and inorganic chemistry (90 [57.3%]). The most commonly recommended courses were social sciences (96 [61.1%]), genetics (96 [61.1%]), and psychology (86 [54.8%]). Humanities had the highest range of credit hours expected (median, 6; range, 3-24) and cell and molecular biology, computer science, physiology, microbiology, and ethics the smallest (median, 3; range, 3-3). College mathematics had the highest proportion of schools accepting pass/fail (n = 15/26 [57.7%]) and AP (n = 51/65 [78.5%]) credits and biochemistry the lowest (n = 18/54 [33.3%] and n = 57/116 [49.1%], respectively). Statistics had the highest proportion of schools accepting online courses (n = 41/54 [75.9%]) and inorganic chemistry the lowest (n = 60/127 [47.2%]). College English had the highest proportion of schools accepting community college credits (n = 102/109 [93.6%]) and cell and molecular biology the lowest (n = 11/15 [73.3%]).</p><p><strong>Conclusions: </strong>These results show substantial variability in premedical course requirements or recommendations among U.S. medical schools, which could be challenging for premedical students planning their undergraduate studies. Additional research is needed on the effect of this variability on students interested in attending medical school.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Education in the Context of War in Ukraine.","authors":"Bohdan O Koshak, Svitlana I Smiyan, Anastasia V Bilukha","doi":"10.1097/ACM.0000000000005956","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005956","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laugh, Listen, and Fold.","authors":"Shahaan S Razak","doi":"10.1097/ACM.0000000000005950","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005950","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unacknowledged Moral Rights of Authorship in Academic Medicine Presentations.","authors":"Sharon Feldman, Giuliana C Antolovich, Monica S Cooper","doi":"10.1097/ACM.0000000000005949","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005949","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial Barriers to Rural Graduate Medical Education: Medicare Funding Methods for Sole Community and Medicare-Dependent Hospitals.","authors":"Mukesh Adhikari, Emily M Hawes, Jacob Rains, Christopher L Francazio, George M Holmes","doi":"10.1097/ACM.0000000000005948","DOIUrl":"10.1097/ACM.0000000000005948","url":null,"abstract":"<p><strong>Purpose: </strong>Policymakers are exploring options to address rural-urban physician maldistribution, including reducing rural residency training barriers. This study estimated Medicare graduate medical education (GME) reimbursement that sole community hospitals (SCHs) and Medicare-dependent hospitals (MDHs) are disqualified from receiving compared with hospitals under the Prospective Payment System (PPS) and calculated the GME reimbursement per resident for MDHs and SCHs under different scenarios.</p><p><strong>Method: </strong>This simulation study used Healthcare Cost Report Information System data on hospitals that had been SCHs or MDHs between 2011 and 2021 and did not have any resident full-time equivalents (FTEs) in the most recent year. Reimbursements were calculated under the PPS and hospital-specific rate (HSR), assuming all other hospital financing elements remained unchanged, apart from adding resident FTEs.</p><p><strong>Results: </strong>A total of 242 hospitals were identified as current or recent SCHs or MDHs with an average daily census of 25 or more and no residents in their most recent cost reports; 139 (57.4%) were paid under the HSR. The median (interquartile range) reimbursement per resident was $179,442 ($153,078-$208,412) under PPS and $107,294 ($85,134-$128,259) under HSR, a difference of nearly $70,000 per resident. The median opportunity cost per FTE was approximately $73,000 for SCHs and approximately $65,000 for MDHs. No significant per-resident differences were observed in the GME payments based on program size. Due to higher GME payments from PPS vs HSR, the number of hospitals defaulting to HSR decreased, and by the end of the third year of the program, more than 10% hospitals switched from HSR to PPS.</p><p><strong>Conclusions: </strong>Under the current health care and GME reimbursement method, SCHs and MDHs face considerable financial barriers to launching or participating in GME programs. Policy adjustments to address this barrier may incentivize more rural facilities to launch or participate in GME, potentially mitigating the geographic maldistribution of physicians.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}